Year

2017

Degree Name

Doctor of Philosophy

Department

School of Computing and Information Technology

Abstract

People living in Residential Aged Care (RAC) homes have higher exposure to various risk factors than their counterparts in the community. Therefore, a risk management approach is essential for client safety. Formal RAC services in Australia are predominantly financed by taxpayers with some user contributions. To protect clients’ safety and quality of life, the Australian government has imposed stringent accreditation standards in RAC services. Therefore, the aged care accreditation program drives the risk management approach in these services.

Various types of information technology solutions have been introduced into RAC services. Among them, electronic health record (EHR) systems are important in supporting the delivery of aged care services and risk management for client safety. To date there is a lack of evidence about the contribution of EHR to the effectiveness of risk management, particularly in supporting the primary risk management goal of meeting accreditation standards. Therefore, this research aimed to explore the contribution of EHR to risk management to meet accreditation standards in RAC homes.

Various types of information technology solutions have been introduced into RAC services. Among them, electronic health record (EHR) systems are important in supporting the delivery of aged care services and risk management for client safety. To date there is a lack of evidence about the contribution of EHR to the effectiveness of risk management, particularly in supporting the primary risk management goal of meeting accreditation standards. Therefore, this research aimed to explore the contribution of EHR to risk management to meet accreditation standards in RAC homes.

3 Abstract Background People living in Residential Aged Care (RAC) homes have higher exposure to various risk factors than their counterparts in the community. Therefore, a risk management approach is essential for client safety. Formal RAC services in Australia are predominantly financed by taxpayers with some user contributions. To protect clients’ safety and quality of life, the Australian government has imposed stringent accreditation standards in RAC services. Therefore, the aged care accreditation program drives the risk management approach in these services. Various types of information technology solutions have been introduced into RAC services. Among them, electronic health record (EHR) systems are important in supporting the delivery of aged care services and risk management for client safety. To date there is a lack of evidence about the contribution of EHR to the effectiveness of risk management, particularly in supporting the primary risk management goal of meeting accreditation standards. Therefore, this research aimed to explore the contribution of EHR to risk management to meet accreditation standards in RAC homes. Methods Secondary research was conducted by text data mining the published aged care accreditation reports. After being automatically downloaded from the government web site, these reports were converted from PDF to computer program readable text format. The relevant information was extracted, loaded and stored. The specific content was labelled for analysis. The relationship between data was explored by quantitative statistical data analysis and data 4 mining of association rules. Qualitative text data analysis was conducted to further explore the reasons for the relationship.

Only 45 (1.25%) of 3,607 accreditation reports published between 7th March 2011 and 25th March 2015 recorded failure in one or more accreditation outcomes, suggesting only a few RAC homes actually failed aged care accreditation. The three outcomes that the RAC homes most often failed were information systems (58%, 26 homes), clinical care (44%, 20 homes) and medication management (40%, 18 homes). Six risk indicators for not meeting the information systems outcome were: no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents’ clinical changes, not providing accurate care plans, and communication processes failure. No significant association was found between failing information systems outcome and the types of information systems to be used, either EHR or paper records.

There were only two significant positive associations between failing the information systems outcome and failing two other outcomes: staff education and development, and clinical care. Failure in the data monitoring mechanism was the common reason for RAC homes to fail in other accreditation outcomes.

The EHR systems did not clearly contribute to risk management in meeting other accreditation outcomes. A number of accreditation failures appeared to be linked to organisational deficiencies that could be improved by use of more effective information systems to improve monitoring mechanisms. Future research should explore the possibilities of improving the design and functionality of EHR to fully support aged care services.

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